Oral bisphosphonate-related osteonecrosis of the jaws: clinical characteristics of a series of 20 cases in Spain
2012
Objective:
The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ)
induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain.
Study
Design:
A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100
km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination
was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years.
Results:
We detected 20 cases of ONJ (24 lesions) related to oral bisphosphonates (alendronate
[16 patients]
and ibandronate
[4 patients]), which were mainly administered as treatment for osteoporosis (17 patients). The mean interval
between initiation of treatment and confirmation of a diagnosis of ONJ was 66±43 months (range, 6-132 months); in
7 patients (35%) the interval was less than 36 months. The past history revealed hypertension in 13 cases (65%) and
diabetes in 4 (20%); 7 patients (35%) were on corticosteroid treatment. Oral surgery had been previously performed
in 13 patients (65%) and the remaining 7 patients (35%) had removable dental prostheses. The lesions most frequently
affected the posterior mandible (62.5%). The majority of the lesions (75%) were classified as stage 2, although lesions
were identified in all established clinical stages (including 2 stage 0 lesions).
Conclusion:
In conclusion, in the present series, ONJ induced by oral bisphosphonates typically develops in women
around 70 years of age, taking alendronate, that underwent oral surgery. Most lesions are located in the posterior
mandible and are classified as stage 2 at diagnosis. Some patients presented no known risk factors, suggesting that
there may be risk factors still to be identified. There are well-defined patterns of clinical presentation that can facilitate early diagnosis of ONJ.
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